Complex Fetal Care Cases: Fetoscopic Myelomeningocele Repair

Abstract

* Abbreviations: CSF: : cerebrospinal fluid MMC: : myelomeningocele MRI: : magnetic resonance imaging VP: : ventriculoperitoneal A 34-year-old gravida 6, para 2-0-3-2 pregnant woman was referred to the fetal center with a diagnosis of fetal lumbosacral myelomeningocele (MMC). Her medical history was significant for polycystic ovarian syndrome, migraine headaches, seasonal allergies, and anxiety. She had a surgical history of wisdom teeth extraction and 2 prior cesarean sections. She was taking prenatal vitamins and using vaginal progesterone for an obstetrical history of 3 early first-trimester spontaneous abortions. She had no family history of neural tube defects, but 1 child with Asperger syndrome and sensory processing disorder and 1 child with speech delay. Prenatal laboratory testing was unremarkable. Imaging at the referring obstetrician’s office was significant for an L3 lesion with a lemon-shaped calvarium, findings of Chiari II malformation in the posterior fossa, and lateral ventricular enlargement with a dangling choroid. Amniocentesis performed by the referring provider showed a normal female karyotype and microarray. She was referred to our center at 23 5/7 weeks’ gestation, with imaging and multidisciplinary team meeting at 24 6/7 weeks’ gestation. The following results were obtained: Figure 1. A. Prerepair fetal magnetic resonance imaging …